Provider Demographics
NPI:1144380155
Name:PYNE, WARREN L JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:L
Last Name:PYNE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 TURNPIKE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375
Mailing Address - Country:US
Mailing Address - Phone:508-238-8521
Mailing Address - Fax:508-238-8523
Practice Address - Street 1:479 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375
Practice Address - Country:US
Practice Address - Phone:508-238-8521
Practice Address - Fax:508-238-8523
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA712236OtherTUFTS
MA1612123Medicaid
MA35394OtherPILGGIM
Y39330OtherBLUE CROSS
MAT58455Medicare ID - Type Unspecified